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HomeMy WebLinkAboutFSE Application 91 Ayers Road o.NN Sf Town of South Windsor — Health Department 1540 Sullivan Ave., South Windsor, CT 06074— Mailing Address 1530 Sullivan Avenue, South Windsor, CT 06074—Office Address Phone Number: (860) 337-6173 Fax: (860) 644-1930 Restaurant Establishment Information New Permit❑ Permit Renewal X❑ ***(Please Print Clearly)*** Name of Establishment: South Windsor Public Schools - Wapping Manager's Name: Diane Heyward Street Address: 91 Ayers Road City, State, Zip Code: South Windsor, CT 06074 Phone#: 860-327-4716 Cell Phone#: Fax#: E-Mail Address: Wapping.fs@yahoo.com Seating Capacity: 171 Please submit latest copy of the Qualified Food Operator/ServSafe certificates to the office. YES X❑ NO ❑ (Required Certificate#: Qualified Food Operator: for 7387187 Class 3 8 4) Name: Diane Hayward Date: 10-20-10 Testing Organization: Servsafe Phone#: 860-327-4716 E-Mail Address: Alternate Phone#: Designated Alternate 1: Brenda Brancuccio Designated Alternate2 : Greg King Restaurant Owner Contact Information Owner's Name: Greg King —Chartwell's Dining Street Address: 161 Nevers Road City, State, Zip Code: South Windsor, CT 06074 Phone#: 860-474-1440 Fax #: E-Mail Address: Gregory.king@compass-usa.com Cell Phone#: Renovations Were there any renovations made last year? YES❑ NO X❑ Will there be any renovations? YES ❑ NO ❑ If Yes, please list all renovations RECEIVED that were done/to be done: JAN 0 3 2017 SOUTH WINDSOR Mailing Address to send Food License Renewal Permit to: HEALTH DEPT. Name of Restaurant/Company: Chartwell's Dining Attention: Greg King Address: 161 Nevers Rd City, State, Zip Code: South Windsor, CT 06074 Town of South Windsor — Health Department N tp� Sf, 1540 Sullivan Ave., South Windsor, CT 06074— Mailing Address r 1530 Sullivan Avenue, South Windsor, CT 06074—Office Address Phone Number: (860) 337-6173 Fax: (860) 644-1930 Phone#: 860-474-1440 Restaurant Menu/List of All Items Served/Sold Latest Menu Attached? YES X❑ NO ❑ NOTE""(Must have latest copy on file) Please list all menu items in as much detail as possible or a copy of a menu attached is applicable. Additional Information Please check one only: State Licenses: ❑ Bakery ❑ Liquor Permit [ 1 None Water Supply: XPublic Private Well Wastewater Disposal: XPublic On-Site _Other (please use space below to explain) Agreement and Signature By submitting this application, I affirm that the facts set lot U i in it are true and complete. I understand that any false statements or other misrepresentations made on this app�cation may result in immediate shutdown or revocation of my Food Service License for the Town of South Windsor. Applicant Name (Print): Gregory King Applicant Signature: Date: I7 /t/ �4 Office Use Only Inspector Name (Print): Inspector Signature: Date: Food Class: 1 ❑ 2 ❑ 3 ❑ 4 ❑ Expiration Date: Date Received: Date Approved: 12/13/2016 Print Menus December 2016 Wapping School Breakfast MONDAY TUESDAY WEDNESDAY THURSDAY FRIDAY Main Entrees Main Entrees • Whole Grain French Toast Honey Granola Sticks Cinnamon Toast Crunch • Cinnamon Toast Crunch Cheerios • Cheerios Frosted Corn Flakes • Frosted Corn Flakes Yogurt,Vanilla,Danimals, • Strawberry Banana Yogurt Crush Cup,4 oz Fruit&Vegetable Bar Strawberry Yogurt • Fresh Whole Fruit Fruit&Vegetable Bar • Assorted Fruit Juice Assorted Chilled Fruit • Fresh Whole Fruit Main Entrees Main Entrees Main Entrees Main Entrees Main Entrees • Whole Grain Bagel Blueberry Banana Smoothie Egg&Cheese Sandwich Whole Grain Blueberry Muffin Scooby Doo Graham Crackers • Cinnamon Toast Crunch Cinnamon Toast Crunch Cinnamon Toast Crunch Cinnamon Toast Crunch Cinnamon Toast Crunch • Cheerios Cheerios Cheerios Cheerios Cheerios • Frosted Corn Flakes Frosted Corn Flakes Frosted Corn Flakes Frosted Corn Flakes Frosted Corn Flakes • Cream Cheese,Light,1 oz Honey Granola Vanilla Yogurt Strawberry Banana Yogurt Strawberry Banana Yogurt • Strawberry Yogurt Strawberry Banana Yogurt Fruit&Vegetable Bar Fruit&Vegetable Bar Strawberry Yogurt Fruit&Vegetable Bar Fruit&Vegetable Bar Assorted Chilled Fruit Fresh Whole Fruit Fruit&Vegetable Bar • Assorted Chilled Fruit Fresh Whole Fruit Fresh Whole Fruit Assorted Fruit Juice Assorted Chilled Fruit • Fresh Whole Fruit Assorted Fruit Juice Fresh Whole Fruit go ® W Main Entrees Main Entrees Main Entrees Main Entrees Main Entrees • Apple Cinnamon Nutrigrain Berry Patch Smoothie Egg&Cheese Sandwich Whole Grain French Toast Honey Granola Bar Cinnamon Toast Crunch Cinnamon Toast Crunch Sticks Cinnamon Toast Crunch • Cinnamon Toast Crunch Cheerios Cheerios Cinnamon Toast Crunch Cheerios • Cheerios Frosted Corn Flakes Frosted Corn Flakes Cheerios Frosted Corn Flakes • Frosted Corn Flakes Honey Granola Vanilla Yogurt Frosted Corn Flakes Yogurt,Vanilla,Danimals, • Low Fat Mozzarella String Strawberry Banana Yogurt Fruit&Vegetable Bar Strawberry Banana Yogurt Crush Cup,4 oz Cheese Fruit&Vegetable Bar Assorted Chilled Fruit Fruit&Vegetable Bar Strawberry Yogurt • Strawberry Yogurt Fresh Whole Fruit Fresh Whole Fruit Fresh Whole Fruit Fruit&Vegetable Bar Fruit&Vegetable Bar Assorted Fruit Juice Assorted Fruit Juice Assorted Chilled Fruit • Assorted Chilled Fruit Fresh Whole Fruit • Fresh Whole Fruit UJ r Main Entrees Main Entrees Main Entrees Main Entrees Main Entrees • Whole Grain Bagel Blueberry Banana Smoothie Egg&Cheese Sandwich Whole Grain Blueberry Muffin Scooby Doo Graham Crackers • Cinnamon Toast Crunch Cinnamon Toast Crunch Cinnamon Toast Crunch Cinnamon Toast Crunch Cinnamon Toast Crunch • Cheerios Cheerios Cheerios Cheerios Cheerios • Frosted Corn Flakes Frosted Corn Flakes Frosted Corn Flakes Frosted Corn Flakes Frosted Corn Flakes • Cream Cheese,Light,1 oz Honey Granola Vanilla Yogurt Strawberry Banana Yogurt Strawberry Banana Yogurt • Strawberry Yogurt Strawberry Banana Yogurt Fruit&Vegetable Bar Fruit&Vegetable Bar Strawberry Yogurt Fruit&Vegetable Bar Fruit&Vegetable Bar Assorted Chilled Fruit Fresh Whole Fruit Fruit&Vegetable Bar • Assorted Chilled Fruit Fresh Whole Fruit Fresh Whole Fruit Assorted Fruit Juice Assorted Chilled Fruit • Fresh Whole Fruit Assorted Fruit Juice Fresh Whole Fruit No School-Winter Vacation No School-Winter Vacation No School-Winter Vacation No School-Winter Vacation No School-Winter Vacation Milk&Condiments:1%Low-fat Milk,Chocolate Fat Free Milk Menus Subject to Change We try our best to serve our menus as posted;however,sometimes last minute changes occur.Please check with the cafe manager prior to the meal if you have any concerns. More Details:http://southwindsor.nutrislice.com/menu/wapping-school/breakfast( This Institution is an equal opportunity provider. Layout,design&code©Nutrislice,Inc.Private and non-commercial uses permitted. https://southwindsor.nutrislice.com/menutwapping-school/breakfasttprint-menu/ 1/1 12/13/2016 Print Menus December 2016 Wapping School Lunch MONDAY TUESDAY WEDNESDAY THURSDAY FRIDAY Main Entrees Main Entrees • Chicken Taco Meat Classic Cheese Pizza • Baked Tortilla Scoops Colorful Tossed Salad • Baked Tortilla Scoops Nachos Fun Lunch • Seasoned Black Beans Corn&Black Bean Salad with • Nachos Fun Lunch Salsa • Corn&Black Bean Salad with Classic American Salsa Cheeseburger • Deli Turkey Fruit&Vegetable Bar • American Cheese Fresh Baby Carrots • Soft Flour Tortilla Power Peas • Salsa Fresh Pear Fruit&Vegetable Bar Assorted Chilled Fruit • Garbanzo Beans • Sliced Cucumbers • Fresh Pear • Assorted Chilled Fruit Main Entrees Main Entrees Main Entrees Main Entrees Main Entrees • Whole Grain Chicken Nuggets Whole Grain French Toast Cheese Stuffed Breadsticks California Chicken Cheese Classic Pepperoni Pizza • Fresh Baked Whole Grain Sticks Marinara Sauce Wrap Colorful Tossed Salad Biscuit Scrambled Eggs Seasoned Broccoli Broccoli Florets Crispy Chicken Caesar Salad • Seasoned Corn Tater Tots PBU Fun Lunch PBU Fun Lunch Whole Grain Breadstick • PBU Fun Lunch Warm Baked Apple Slices Classic American Honey Ham PBU Fun Lunch • Classic American PBU Fun Lunch Cheeseburger American Cheese Classic American Cheeseburger Honey Ham Fruit&Vegetable Bar Soft Flour Tortilla Cheeseburger Fruit&Vegetable Bar American Cheese Fresh Broccoli Florets Fruit&Vegetable Bar Fruit&Vegetable Bar • Fresh Baby Carrots Soft Flour Tortilla Fresh Baby Carrots Garbanzo Beans Fresh Baby Carrots • Sweet Corn Salad w/Ranch Fruit&Vegetable Bar Fresh Whole Fruit Sliced Cucumbers Power Peas Dressing - Fresh Celery Sticks Fresh Orange Wedges Fresh Whole Fruit Fresh Whole Fruit • Fresh Whole Fruit Garbanzo Beans Fresh Orange Wedges Fresh Orange Wedges • Fresh Orange Wedges Fresh Whole Fruit • Fresh Orange Wedges Main Entrees Main Entrees Main Entrees Main Entrees Main Entrees • Meatballs in Zesty Marinara Teriyaki Chicken Cheese Stuffed Breadsticks Chicken Bacon Cheddar Melt Classic Cheese Pizza • Whole Grain Rotini Asian Brown Rice Marinara Sauce Orange Glazed Carrots Colorful Tossed Salad • Marinara Sauce Seasoned Broccoli Seasoned Corn Bagel with Yogurt and String Chicken and Cheese Chef • Savory Green Beans Bagel with Yogurt and String Bagel with Yogurt and String Cheese Salad • Bagel with Yogurt and String Cheese Cheese Deli Turkey Whole Grain Breadstick Cheese Deli Turkey Crispy Chicken Patty American Cheese Bagel with Yogurt and String • Crispy Chicken Patty American Cheese Sandwich Soft Flour Tortilla Cheese Sandwich Soft Flour Tortilla Fruit&Vegetable Bar Fruit&Vegetable Bar Crispy Chicken Patty Fruit&Vegetable Bar Fruit&Vegetable Bar Fresh Broccoli Florets Corn&Black Bean Salad with Sandwich • Fresh Baby Carrots Fresh Celery Sticks Fresh Baby Carrots Salsa Fruit&Vegetable Bar • Sweet Corn Salad w/Ranch Garbanzo Beans Fresh Whole Fruit Sliced Cucumbers Fresh Baby Carrots Dressing Fresh Whole Fruit Fresh Cinnamon Orange Fresh Whole Fruit Power Peas • Fresh Whole Fruit Fresh Cinnamon Orange Smiles Fresh Cinnamon Orange Fresh Whole Fruit • Fresh Cinnamon Orange Smiles Smiles Fresh Cinnamon Orange Smiles Smiles ®i r Lj Main Entrees Main Entrees Main Entrees Main Entrees Main Entrees • Whole Grain Chicken Nuggets Whole Grain Pancakes Cheese Stuffed Breadsticks General Tso's Chicken Classic Pepperoni Pizza • Roasted Carrot"Fries" Turkey Sausage Patties Marinara Sauce Broccoli&Cauliflower Florets Colorful Tossed Salad • Whole Grain Pretzel Warm Baked Fresh Apple Colorful Tossed Salad Asian Brown Rice Chicken Caesar Salad • PBU Fun Lunch Slices PBU Fun Lunch PBU Fun Lunch Whole Grain Breadstick • Classic American PBU Fun Lunch Classic American Honey Ham PBU Fun Lunch Cheeseburger Honey Ham Cheeseburger American Cheese Classic American Fruit&Vegetable Bar American Cheese Fruit&Vegetable Bar Soft Flour Tortilla Cheeseburger • Fresh Baby Carrots Soft Flour Tortilla Fresh Broccoli Florets Fruit&Vegetable Bar Fruit&Vegetable Bar • Sweet Corn Salad wl Ranch Breakfast Syrup Fresh Baby Carrots Citrus Kidney and Garbanzo Fresh Baby Carrots Dressing Fruit&Vegetable Bar Fresh Whole Fruit Bean Salad Power Peas • Fresh Whole Fruit Fresh Celery Sticks Cranberry Pear Fruit Salad Sliced Cucumbers Fresh Whole Fruit • Cranberry Pear Fruit Salad Citrus Kidney and Garbanzo Fresh Whole Fruit Cranberry Pear Fruit Salad Bean Salad Cranberry Pear Fruit Salad • Fresh Whole Fruit • Cranberry Pear Fruit Salad https://southwindsor.nutrislice.com/menutwapping-schoolAunch/print-menu/ 1/2 12/13/2016 Print Menus No School-Winter Vacation No School-Winter Vacation No School-Winter Vacation No School-Winter Vacation No School-Winter Vacation Milk&Condiments:Chocolate Fat Free Milk,1%Low-fat Milk,Skim Milk,Strawberry Skim Milk,Ketchup,Yellow Mustard,Mayo,Fat Free Ranch Dressing Menus Subject to Change We try our best to serve our menus as posted;however,sometimes last minute changes occur.Please check with the cafe manager prior to the meal if you have any concerns. More Details:http://southwindsor.nutrislice.com/menutwapping-schoolAunch/ This Institution is an equal opportunity provider. Layout,design&code©Nutrislice,Inc.Private and non-commercial uses permitted https://southwindsor.nutrislice.com/menutwapping-schoolAunclVprint-menu/ 2/2